Make confident decisions about your Medicare coverage with a clear, simple guide.
Medicare is divided into four parts, each offering unique coverage. Here’s what you need to know:
around your 65th birthday
if you qualify due to life events
October 15 – December 7
Understanding what’s not included helps you plan with confidence.
Routine exams, cleanings, dentures
Eye exams for glasses, frames, contact lenses
Hearing aids and fittings
Custodial care (nursing homes, assisted living)
Most services received abroad
Unless medically necessary
Many individuals choose additional coverage to reduce out-of-pocket costs and access services not included in Original Medicare. Supplemental plans can help provide added protection, flexibility, and peace of mind.
Understanding your options shouldn’t feel overwhelming. Here’s a simple breakdown of common Medicare plans and programs.
Available in some areas, a Medicare Cost Plan may allow you to receive care outside the network. If you do, Medicare-covered services are generally paid based on Original Medicare rules. Emergency and urgent care are covered.
Most Medicare HMO plans require members to use doctors, hospitals, and providers within the plan’s network, except in emergencies. Many also require a referral from a primary care doctor before seeing a specialist.
An MSA plan combines a high-deductible Medicare Advantage plan with a medical savings account. Medicare deposits money into the account to help pay for qualified healthcare expenses.
A PPO plan allows members to use providers both inside and outside the network, but costs are usually lower when using preferred in-network providers.
A PFFS plan sets its own payment terms for providers and determines how much members pay for care. Costs and rules can differ from Original Medicare, so it is important to review plan details carefully.
A type of Medigap policy that may require you to use certain hospitals and, in some cases, certain doctors in order to receive full benefits.
A Medicare Advantage plan designed for people with specific needs, such as those with certain chronic conditions, those living in institutions, or those eligible for both Medicare and Medicaid.
A state-run program that may help pay some Medicare costs, such as premiums, deductibles, and coinsurance, for individuals with limited income and resources.
Special projects created to test improvements in Medicare coverage, payment models, or quality of care. These may also be called demonstrations.
PACE provides comprehensive medical and social services for certain older adults, helping coordinate care in the community rather than in a nursing home setting when appropriate.
A free counseling program funded by the federal government that helps Medicare beneficiaries understand their options and make informed decisions about coverage.
A state-based program that may help eligible individuals with prescription drug costs, depending on age, income, or health condition.
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Choosing health insurance does not have to be overwhelming. I’m here to guide you through your options and help you find coverage that fits your needs.
